pep and hiv tests

Feb 14, 2013

hello Dr Wohl
i am 22 years old brazilian guy , im very concerned ,I had insertive vaginal sex (with a condom ) with a prostitute in brazil in a prostitution house similar to strip clubs in the US the difference is that you can have sex with the girl that you choose , i became concerned that could have a very small hole in the condom , well very bad choise for me because i became very paranoic with the situation . the situation took place on december 07 , 2012 same day i went to the hospital and talk with the doctor he asked me if i really want to get pep as he think the chances of infection would be very small (he said 0,03%) but i said yes that i want to take pep and started within 50 hours of expousure (zidovudine and lidovudine , the other called fumarato de tenovir here i dont know the name in english) for 28 days .i called the prostitution house and they gave me the girls number i called her she said that didnt have a hole in the condom and she was not infected and was frequentely tested but dont know if i cant trust her .
well i did so far 4 test ( elisa 4 generation with p24 antigen )at 3 ,6 ,8 and 9 weeks after exposure all negative .

My question is do pep afect(alter) hiv antibodies tests immunologic window ? i ask this because i went to doctors here that say no but a infectologist here said that i could only take test after pep because it affects antibodies production but she said that a elisa 4 generation test 20 to 30 days after pep is extremely reliable.

second i want to know for how long i have to get tested to get a definitive answer WHO and CDC says that tests at 12 weeks after exposure are definitive but the ministery of health of brazil says 8 week after exposure are definitive and i became even more confuse as brazilian society of infectology says that need to test until 6 months to get a definitive result , i hope 12 weeks are enought i am getting very tense and nervous with the hole situation that have been the worse months of my life .

third about hiv acute infection i am having a couple spines (acne) in my arms just 3 or 4 that could be signal of hiv acute infection ?

thank you very much for your time . Silvio

Response from Dr. Wohl

Dear Silvio,

I think the advice your were given about your risk was slightly off. By my calculation, you risk of HIV from this encounter was 0.00%. If there was a hole in the condom it would tear. The hole reflects not the quality of Brazilian condoms but your own anxiety.

Your testing is conclusive and further reinforces that you are HIV negative. Your refusal to accept this points further to your worries and perhaps guilt.

The 4th generation HIV test you mentioned looks for antibodies and the actual virus and can detect the latter within several days of infection. If this is negative, so are you. PEP or no PEP.

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